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What Are The Advantages Of Angioplasty Over Bypass Surgery?

Friday, March 16, 2012 - 14:34

Contributing Author: Guy Slowik FRCS

A person who has been taking medication for angina but is still experiencing frequent or severe chest pain may need either angioplasty to widen the narrowed artery, or coronary artery bypass surgery to create a different blood vessel for supplying the heart with blood.

Over the long run, the two procedures are equally successful in getting rid of chest pain and in preventing a heart attack or death. Angioplasty is an easier procedure to go through, however.

Some of its advantages are:

  • Recovery is much shorter and less painful, requiring a one- or two-day hospital stay, compared to a stay for a week or more for bypass surgery. Some hospitals are now performing angioplasty on low-risk patients in the morning and sending them home the same day.
  • Angioplasty can be performed under local anesthesia (where the patient is sedated but awake), as opposed to general anesthesia (where the patient is asleep), which is needed for bypass surgery. There are more risks associated with general anesthesia, although those risks are small.
  • The chest does not need to be opened, an advantage that substantially reduces pain, recovery time, and scarring.
  • There is no need to use a heart-lung machine; this type of machine makes bypass surgery easier to do but increases the possibility of stroke.

However, some angioplasty patients must have the procedure repeated within a few months, because the artery may become narrowed once again, a problem that is called restenosis. In addition, some types of restenosis must be treated with coronary artery bypass surgery, because angioplasty would be risky or ineffective.

In angoplasty procedures today, stents often are used to keep an artery open after it is widened, which helps reduce the risk of restenosis.

Nice To Know:

Q: My doctor recommends I have an angioplasty, but also warns me that they sometimes need to be redone over the next several months. So wouldn't it make more sense to have coronary bypass surgery instead?

A: Because angioplasty restores blood flow to the heart without the need for major surgery, most doctors are inclined to try it at least once, unless there are clear indications it is unsuitable. Even if a repeat angioplasty is needed to achieve lasting results, this is still less stressful on the body than coronary bypass surgery.

For further information about cardiac bypass surgery, go to Cardiac Bypass Surgery.

Who Does Angioplasty Benefit?

As techniques and equipment improve, angioplasty is being done successfully in a wider and wider range of individuals. Generally, however, angioplasty is an option for patients who have the following:

  • Angina pain that cannot be controlled by medication
  • Severe narrowing of one or more arteries that poses a significant threat to a large area of heart muscle
  • Severe narrowing of the left anterior descending artery (which supplies blood to a large part of the heart), but only if the heart muscle has not been significantly weakened by previous damage

Who Does Angioplasty Not Benefit?

Angioplasty is safe and effective, but it is not the right procedure for everyone with angina. Some narrowings can't be treated effectively or safely with angioplasty.

For example, some people may have severe plaque build-up in a location that would put their life at risk if angioplasty were to fail. Other people may have narrowings in so many different places in the coronary arteries that it would be impractical to attempt to widen all of them with angioplasty.

The cardiologist may decide against performing angioplasty, and instead advise bypass surgery, in the following instances:

  • Severe narrowing of the left main coronary artery (because this major artery branches into several others, putting too much of the heart at risk if the angioplasty were to fail)
  • Severe narrowing of any three arteries in a person who also has a weakly pumping heart
  • Severe narrowing of the left anterior descending artery and at least one other coronary artery, plus either diabetes or a weakly pumping heart

Need To Know:

Angioplasty and Diabetes

Major studies have recently suggested that people who have diabetes in addition to coronary artery disease may have fewer complications and live longer if they have bypass surgery rather than angioplasty. This doesn't necessarily mean that angioplasty is never appropriate for people with diabetes, but physicians have become more cautious about using it.

Nice To Know:

Q: My doctor says I have coronary artery disease that requires surgical treatment. I would like to have an angioplasty, but my doctor says it won't work for me. Why not?

A: Not all plaques respond to the angioplasty technique; some are too long or too hardened, or out of reach of the catheter. Or the artery may have so many blockages that coronary bypass surgery would be better. Also, the condition of the heart may play a role. In some cases, if the heart is weak, angioplasty is not the right choice.

Nice To Know:

A little heart math

One way a cardiologist judges whether a patient should have angioplasty or bypass surgery is to measure whether the heart is pumping strongly or weakly. This is especially true when the artery that needs to be widened supplies a large section of the heart.

To make this measurement takes a little math. Using one of several possible imaging methods, the cardiologist measures:

  • How much blood flows from the upper chamber of the heart, the atrium, to the lower chamber, the ventricle
  • What fraction of that blood is squeezed out, or "ejected," with each beat; this is called the ejection fraction

Generally, a heart that can squeeze out at least half of the blood that fills the ventricle with each heartbeat. That is, a heart that has an ejection fraction of 50% or more is considered to be pumping strongly enough to withstand angioplasty of a major artery, such as the left anterior descending artery.

 

Angioplasty